Professional Care Manager-Care Management, Community Osteopathic Hospital

University of Pittsburgh Medical Center • Harrisburg, PA

416d

About The Position

The Care Manager at UPMC Community Osteopathic Hospital is responsible for coordinating clinical and financial plans for patients, ensuring effective utilization management, discharge planning, and post-acute care referrals. This full-time position requires collaboration with a multi-disciplinary team to facilitate safe discharges and manage resources effectively, while also adhering to regulatory requirements and promoting patient safety.

Requirements

• Graduate of approved school of nursing.
• Two (2) years of nursing experience required.
• Current licensure as a Registered Professional Nurse in the state of practice or in a state covered by a licensure compact agreement.
• UPMC Corporate Care Management Training Certificate of Completion required within 4-6 weeks of hire.
• BSN or related Bachelor's degree preferred.
• Previous case management experience preferred.
• Knowledge of healthcare financial and payer issues preferred.
• Knowledge of state, local, and federal programs preferred.
• Use of InterQual criteria preferred.

Nice To Haves

• Previous case management experience preferred.
• Knowledge of healthcare financial and payer issues preferred.
• Knowledge of state, local, and federal programs preferred.
• Use of InterQual criteria preferred.

Responsibilities

• Reviews medical record daily to ensure patient continues to meet level of care (LOC) requirements and that chart documentation supports LOC determination.
• Collaborates with patients, caregivers, internal/external healthcare providers, agencies, and payers to plan and execute a safe discharge.
• Re-evaluates and revises discharge plan as patient clinical condition merits, developing alternative discharge plans as needed.
• Uses InterQual criteria to justify appropriate LOC and obtain necessary payer authorizations for post-acute care.
• Documents Freedom of Choice regarding post-acute services.
• Serves as a resource to clinical and finance teams for clinical documentation requirements and insurance coverage issues.
• Attends department meetings and training sessions to maintain knowledge of payer and regulatory requirements.
• Promotes patient safety and supports CORE measures for JCAHO requirements.
• Takes leadership role in concurrent denial process, working with the clinical team to obtain necessary documentation to support LOC.
• Starts discharge planning on admission and ensures documentation is updated regularly, identifying barriers to discharge.
• Performs clinical review on admission and/or continued stay using InterQual criteria to determine appropriate level of care.

Benefits

• Generous sign-on bonus.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree